1
|
Interleukin-18 and Gelsolin Are Associated with Acute Kidney Disease after Cardiac Catheterization. Biomolecules 2023; 13:biom13030487. [PMID: 36979422 PMCID: PMC10046301 DOI: 10.3390/biom13030487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Patients undergoing cardiac catheterization are at high risk of post-procedure acute kidney injury (AKI) and may experience persistent renal damage after an initial insult, a state known as acute kidney disease (AKD). However, the association between AKD and urinary renal biomarkers has not yet been evaluated in this population. We enrolled 94 patients who underwent elective cardiac catheterization to investigate patterns of urinary renal biomarkers and their associations with post-procedure AKD. Serial urinary renal biomarker levels were measured during pre-procedure, early post-procedure (12–24 h), and late post-procedure (7–10 days) periods. In our investigation, 42.55% of the enrolled patients developed AKD during the late post-procedure period. While the liver-type free-fatty-acid-binding protein level increased sharply during the early post-procedure period, it returned to baseline during the late post-procedure period. In contrast, interleukin-18 (IL-18) levels increased steadily during the post-procedure period. Early post-procedure ratios of IL-18 and gelsolin (GSN) were independently associated with subsequent AKD (odds ratio (95% confidence interval), 4.742 (1.523–14.759) for IL-18 ratio, p = 0.007; 1.812 (1.027–3.198) for GSN ratio, p = 0.040). In conclusion, post-procedure AKD is common and associated with early changes in urinary IL-18 and GSN in patients undergoing cardiac catheterization.
Collapse
|
2
|
Yue RZ, Li YJ, Su BH, Li CJ, Zeng R. Atorvastatin reduces contrast media-induced pyroptosis of renal tubular epithelial cells by inhibiting the TLR4/MyD88/NF-κB signaling pathway. BMC Nephrol 2023; 24:25. [PMID: 36732683 PMCID: PMC9893683 DOI: 10.1186/s12882-023-03066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is the third most common cause of hospital-acquired renal failure. However, there is no effective treatment of CI-AKI, and its mechanism is unknown. Interestingly, atorvastatin has been reported to be effective in renal injury. Therefore, the aim of this study was to explore the effect and possible molecular mechanism of atorvastatin in CI-AKI. METHODS On the CI-AKI in vitro model, rat tubular epithelial cells (NRK-52E) were treated with 18 mg I/ml meglumine diatrizoate (MEG) and then pretreated with atorvastatin. pcDNA3.1-TLR4 treatment was performed to overexpress toll-like receptor 4 (TLR4) in NRK-52E cells. Cell Counting Kit-8 (CCK-8) and lactate dehydrogenase (LDH) kits were used to detect NRK-52E cell viability as well as LDH release in each group, respectively; qRT-PCR to determine mRNA expression of TLR4 in cells; western blot to detect protein expression levels of pyroptosis-related proteins (NLRP3, caspase-1, ASC, and GSDMD) and TLR4/MyD88/NF-κB signaling pathway-related proteins (TLR4, MyD88, NF-κBp65, and p-NF-κB p65) in cells. RESULTS MEG treatment significantly inhibited the viability of NRK-52E cells, increased pro-inflammatory factor levels and promoted pyroptosis, representing successful establishment of a rat tubular epithelial cell (NRK-52E) CI-AKI in vitro model. Notably, atorvastatin increased the activity of MEG-treated NRK-52E cells and alleviated cell injury in a concentration-dependent manner. In addition, atorvastatin significantly down-regulated the expression of TLR4 in MEG-treated NRK-52E cells. However, overexpression of TLR4 inhibited the effects of atorvastatin on increasing cell viability, alleviating cell injury, reducing pro-inflammatory factors (IL-1β, IL-6, and TNF-α) levels, and inhibiting apoptosis (by down-regulating the expression of NLRP3, caspase-1, ASC, and GSDMD). Furthermore, atorvastatin also inhibited the expression of TLR4/MyD88/NF-κB pathway-related proteins (TLR4, MyD88, and p-NF-κB p65). CONCLUSION Atorvastatin can attenuate CI-AKI through increasing the activity of MEG-treated renal tubular epithelial cells, relieving cell injury, as well as inhibiting pyroptosis and inflammation. More importantly, the mechanism was achieved by inhibiting the TLR4//MyD88/NF-κB signaling pathway.
Collapse
Affiliation(s)
- Rong-zheng Yue
- grid.13291.380000 0001 0807 1581Department of nephrology, West China Hospital, School of Clinic Medicine, Sichuan University, 610041 Chengdu, Sichuan China
| | - Ya-juan Li
- grid.13291.380000 0001 0807 1581Department of nephrology, West China Hospital, School of Clinic Medicine, Sichuan University, 610041 Chengdu, Sichuan China
| | - Bai-hai Su
- grid.13291.380000 0001 0807 1581Department of nephrology, West China Hospital, School of Clinic Medicine, Sichuan University, 610041 Chengdu, Sichuan China
| | - Cong-jun Li
- grid.13291.380000 0001 0807 1581Department of nephrology, West China Hospital, School of Clinic Medicine, Sichuan University, 610041 Chengdu, Sichuan China
| | - Rui Zeng
- Department of Cardiovascular diseases, West China Hospital, School of Clinic Medicine, Sichuan University, 610041, Chengdu, Sichuan, China.
| |
Collapse
|
3
|
Soomro QH, Anand ST, Weisbord SD, Gallagher MP, Ferguson RE, Palevsky PM, Bhatt DL, Parikh CR, Kaufman JS. The Relationship between Rate and Volume of Intravenous Fluid Administration and Kidney Outcomes after Angiography. Clin J Am Soc Nephrol 2022; 17:1446-1456. [PMID: 36008352 PMCID: PMC9528263 DOI: 10.2215/cjn.02160222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/27/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Contrast-associated AKI may result in higher morbidity and mortality. Intravenous fluid administration remains the mainstay for prevention. There is a lack of consensus on the optimal administration strategy. We studied the association of periprocedure fluid administration with contrast-associated AKI, defined as an increase in serum creatinine of at least 25% or 0.5 mg/dl from baseline at 3-5 days after angiography, and 90-day need for dialysis, death, or a 50% increase in serum creatinine. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a secondary analysis of 4671 PRESERVE participants who underwent angiographic procedures. Although fluid type was randomized, strategy of administration was at the discretion of the clinician. We divided the study cohort into quartiles by total fluid volume. We performed multivariable logistic regression, adjusting for clinically important covariates. We tested for the interaction between fluid volume and duration of fluid administration, categorized as <6 or ≥6 hours. RESULTS The mean (SD) age was 70 (8) years, 94% of participants were male, and median (interquartile range) eGFR was 60 (41-60) ml/min per 1.73 m2. The range of fluid administered was 89-882 ml in quartile 1 and 1258-2790 ml in quartile 4. Compared with the highest quartile (quartile 4) of fluid volume, we found a significantly higher risk of the primary outcome in quartile 1 (adjusted odds ratio, 1.58; 95% confidence interval, 1.06 to 2.38) but not in quartiles 2 and 3 compared with quartile 4. There was no difference in the incidence of contrast-associated AKI across the quartiles. The interaction between volume and duration was not significant for any of the outcomes. CONCLUSIONS We found that administration of a total volume of 1000 ml, starting at least 1 hour before contrast injection and continuing postcontrast for a total of 6 hours, is associated with a similar risk of adverse outcomes as larger volumes of intravenous fluids administered for periods >6 hours. Mean fluid volumes <964 ml may be associated with a higher risk for the primary outcome, although residual confounding cannot be excluded.
Collapse
Affiliation(s)
| | - Sonia T. Anand
- VA Boston Health Care System Massachusetts Veterans Epidemiology Research and Information Center, Boston, Massachusetts
| | - Steven D. Weisbord
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Ryan E. Ferguson
- VA Boston Health Care System Massachusetts Veterans Epidemiology Research and Information Center, Boston, Massachusetts
- VA Cooperative Studies Program Coordinating Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Paul M. Palevsky
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Chirag R. Parikh
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James S. Kaufman
- New York University Grossman School of Medicine, New York, New York
- Renal Section, VA New York Harbor Healthcare Center, New York, New York
| |
Collapse
|
4
|
Mezhonov EM, Vyalkina YA, Shalaev SV. N-acetylcysteine in the Prevention of Contrast-induced Acute Kidney Injury: a Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-08-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To analyze the currently available published randomized controlled clinical trials to evaluate the effect of N-acetylcysteine on the incidence of contrast-induced acute kidney injury (CI-AKI).Material and methods. The meta-analysis was performed in accordance with the PRISMA guidelines based on a search of existing literature in the PubMed/MEDLINE database for the period from 2015 to 16 February 2022. Keywords included MeSH terms «acute kidney injury» or «contrast-induced nephropathy» or «AKI» or «CIN» and «contrast media» and «N-acetylcysteine». The RoB 2 tool was used to assess study bias.Results: When searching based on the initially selected statistics, 98 publications were identified, some of them were excluded from the analysis due to non-compliance with the inclusion criteria in this meta-analysis, 7 studies of unused sources of detection were ultimately selected, the total number of patients in the discovery was 10394.The results of the meta-analysis revealed that in patients treated with N-acetylcysteine CI-AKI developed with the same frequency as in patients who did not observe such therapy as a prophylaxis for this disease (odds ratio 1.06, 95% confidence interval 0.911.23, p=0.46).Conclusion. The use of N-acytelcysteine does not offer any advantage in reducing the incidence of CI-AKI compared with the administration of saline solutions (sodium bicarbonate or sodium chloride 0.9%) or placebo.
Collapse
Affiliation(s)
- E. M. Mezhonov
- Regional clinical hospital №1; Tyumen State Medical University
| | | | - S. V. Shalaev
- Regional clinical hospital №1; Tyumen State Medical University
| |
Collapse
|
5
|
Prevention and Management of AKI in ACS Patients Undergoing Invasive Treatments. Curr Cardiol Rep 2022; 24:1299-1307. [PMID: 35925513 DOI: 10.1007/s11886-022-01742-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Management of patients presenting with acute coronary syndrome (ACS) includes invasive procedures that may increase the risk of acute kidney injury (AKI). AKI adversely affects the outcomes of such procedures and complicates the management of ACS. We have summarized several strategies for the prevention and management of AKI in this critical patient group including in the pre-procedural, intraprocedural, and post-procedural settings. RECENT FINDINGS Definitive prevention and management strategies for AKI in patients presenting with ACS requiring invasive management can be confounded by the variation in data outcomes. Pre-procedural hydration with normal saline when accounting for time to catheterization, radial artery access, contrast stewardship, and close monitoring of renal function after catheterization should be implemented.
Collapse
|
6
|
Magner K, Ilin JV, Clark EG, Kong JWY, Davis A, Hiremath S. Meta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2220671. [PMID: 35788669 PMCID: PMC9257561 DOI: 10.1001/jamanetworkopen.2022.20671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE The most suitable analytic method to systematically analyze numerous trials with contradictory results is unclear. Multiple trials assessing the use of N-acetylcysteine (NAC) for prevention of contrast-induced acute kidney injury (CI-AKI) have had contradictory results with recent trials confirming a lack of benefit. OBJECTIVE To systematically review the literature on NAC for the prevention of CI-AKI, and to explore the heterogeneity, publication bias, and small-study effect to determine the most suitable analytic method in a setting where the literature is contradictory. DATA SOURCES Medline, Embase, and Cochrane Central Register of Controlled Trials databases were used to find randomized clinical trials (RCTs) comparing NAC with any other prophylactic agent or placebo in adults. STUDY SELECTION The search included studies published in English from database inception to January 2020. Two independent reviewers screened the studies, extracted data, and performed the risk of bias assessment. DATA EXTRACTION AND SYNTHESIS A meta-analysis was conducted about the effect of NAC on CI-AKI, the need for dialysis, and mortality. Fixed and random effects analyses were also performed. Funnel plots and the trim and fill method were used for assessment of publication bias. Metaregression was performed to explore the heterogeneity and subgroup analysis to examine the association between NAC and CI-AKI when studies were categorized according to sample size and number of events. RESULTS A total of 101 trials were included in this meta-analysis. The median sample size was 112 (range, 20 to 4993). Twenty-nine trials had a sample size of 200 or more, and only 3 trials had a sample size of 500 or more. Forty-five trials reported the need for kidney replacement therapy, and 41 trials reported mortality as an outcome. NAC seemed to show a benefit, with a pooled OR of 0.72 (95% CI, 0.63-0.82) using random effects model and a pooled OR of 0.82 (95% CI 0.76-0.90) using a fixed effects model. However, there was significant heterogeneity (I2 = 37.6; P < .001) and significant publication bias, which was reduced only when restricting to large RCTs (N ≥ 500). The clinical outcomes (ie, the need for kidney replacement therapy and mortality) revealed little heterogeneity and no publication bias, and each provided a robust neutral summary result. CONCLUSIONS AND RELEVANCE In this meta-analysis, NAC was associated with a benefit in the prevention of CI-AKI. However, because of substantial publication bias and other biases, standard meta-analytic techniques resulted in significant heterogeneity and a spurious, or factitious, association, even when using a random effects model. When the analysis was restricted to RCTs with a large sample size to account for publication bias or restricted to trials with clinical outcomes, this issue was reduced and resulted in more robust and neutral effect sizes.
Collapse
Affiliation(s)
- Kate Magner
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Edward G. Clark
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Kidney Research Institute, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jennifer W. Y. Kong
- Kidney Research Institute, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexandra Davis
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Kidney Research Institute, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
7
|
Wu MY, Lo WC, Wu YC, Lin TC, Lin CH, Wu MS, Tu YK. The Incidence of Contrast-Induced Nephropathy and the Need of Dialysis in Patients Receiving Angiography: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:862534. [PMID: 35573008 PMCID: PMC9091353 DOI: 10.3389/fmed.2022.862534] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe risk of dialysis following contrast exposure is unclear. We aimed to examine the overall risk of contrast induced nephropathy and the need of dialysis based on a systematic review with random-effects meta-analysis.MethodsWe searched the electronic database including PubMed, Medline, Embase, and Cochrane Library from inception to 31 October, 2020 with predetermined search term to identify relevant studies. Observational studies investigating the association between contrast induced nephropathy after angiography and the need of dialysis were included, and summary risks were estimated. Two independent reviewers extracted the data, followed with random effects model to calculate the overall pooled incidence of contrast induced nephropathy and the need of dialysis after angiography. Subgroup-analysis and meta-regression were performed to assess heterogeneity of incidence across studies.ResultsOf 2,243 identified articles, 259 met our inclusion criteria were included in the meta-analysis after screening. Pooled effect estimates had the following summary incidence proportion for contrast induced nephropathy after angiography: 9.06% (95% CI: 8.53–9.58%; derived from 120 studies) and 0.52% (95% CI: 0.37–0.70%; derived from 110 studies) for the need of dialysis, respectively. The stratified summary incidence proportion of contrast induced nephropathy after contrast administration via intra-arterial route was 9.60% (95% CI: 9.0–10.2%; derived from 106 studies) and was 0.6% (95% CI: 0.40–0.80%; derived from 100 studies) for the need of dialysis, respectively. Our meta-regressions found that the amount of contrast medium exposure was associated with contrast-induced nephropathy.ConclusionThe potential risk of dialysis needs to be communicated to patients undergoing procedures requiring contrast, especially via intra-arterial exposure.Systematic Review Registration[https://reurl.cc/8Wrlry], identifier [CRD42020170702].
Collapse
Affiliation(s)
- Mei-Yi Wu
- College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Wei-Cheng Lo
- College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yun-Chun Wu
- College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsu-Chen Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Department of Orthopedics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Hung Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Yu-Kang Tu
- College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- *Correspondence: Yu-Kang Tu,
| |
Collapse
|
8
|
Huang WC, Wang MT, Lai TS, Lee KH, Shao SC, Chen CH, Su CH, Chen YT, Sung JM, Chen YC. Nephrotoxins and acute kidney injury - The consensus of the Taiwan acute kidney injury Task Force. J Formos Med Assoc 2022; 121:886-895. [PMID: 34998658 DOI: 10.1016/j.jfma.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 12/01/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022] Open
Abstract
The Taiwan Acute Kidney Injury (AKI) Task Force conducted a review of data and developed a consensus regarding nephrotoxins and AKI. This consensus covers: (1) contrast-associated AKI; (2) drug-induced nephrotoxicity; (3) prevention of drug-associated AKI; (4) follow up after AKI; (5) re-initiation of medication after AKI. Strategies for the avoidance of contrast media related AKI, including peri-procedural hydration, sodium bicarbonate solutions, oral N-acetylcysteine, and iso-osmolar/low-osmolar non-ionic iodinated contrast media have been recommended, given the respective evidence levels. Regarding anticoagulants, both warfarin and new oral anticoagulants have potential nephrotoxicity, and dosage should be reduced if renal pathology exam proves renal injury. Recommended strategies to prevent drug related AKI have included assessment of 5R/(6R) reactions - risk, recognition, response, renal support, rehabilitation and (research), use of AKI alert system and computerized decision support. In terms of antibiotics-associated AKI, avoiding concomitant administration of vancomycin and piperacillin-tazobactam, monitoring vancomycin trough level, switching from vancomycin to teicoplanin in high-risk patients, and replacing conventional amphotericin B with lipid-based amphotericin B have been shown to reduce drug related AKI. With respect to non-steroidal anti-inflammatory drug associated AKI, it is recommended to use these drugs cautiously in the elderly and in patients receiving renin-angiotensin-aldosterone system inhibitors/diuretics triple combinations.
Collapse
Affiliation(s)
- Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Tzu Wang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chien-Hao Chen
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Hao Su
- Department of Pharmacy, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yih-Ting Chen
- Division of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Junne-Ming Sung
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yung-Chang Chen
- Division of Critical Care Nephrology, Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taiwan.
| |
Collapse
|
9
|
Shroff GR, Carlson MD, Mathew RO. Coronary Artery Disease in Chronic Kidney Disease: Need for a Heart-Kidney Team-Based Approach. Eur Cardiol 2021; 16:e48. [PMID: 34950244 PMCID: PMC8674634 DOI: 10.15420/ecr.2021.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/19/2021] [Indexed: 01/10/2023] Open
Abstract
Chronic kidney disease and coronary artery disease are co-prevalent conditions with unique epidemiological and pathophysiological features, that culminate in high rates of major adverse cardiovascular outcomes, including all-cause mortality. This review outlines a summary of the literature, and nuances pertaining to non-invasive risk assessment of this population, medical management options for coronary heart disease and coronary revascularisation. A collaborative heart-kidney team-based approach is imperative for critical management decisions for this patient population, especially coronary revascularisation; this review outlines specific periprocedural considerations pertaining to coronary revascularisation, and provides a proposed algorithm for approaching revascularisation choices in patients with end-stage kidney disease based on available literature.
Collapse
Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin Healthcare & University of Minnesota Medical School Minneapolis, MN, US
| | - Michelle D Carlson
- Division of Cardiology, Department of Medicine, Hennepin Healthcare & University of Minnesota Medical School Minneapolis, MN, US
| | - Roy O Mathew
- Division of Nephrology, Department of Medicine, Columbia VA Health Care System Columbia, SC, US
| |
Collapse
|
10
|
Burnaska DR, Huang GD, O'Leary TJ. Clinical trials proposed for the VA Cooperative Studies Program: Success rates and factors impacting approval. Contemp Clin Trials Commun 2021; 23:100811. [PMID: 34307958 PMCID: PMC8287148 DOI: 10.1016/j.conctc.2021.100811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 04/26/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
The process by which funding organizations select among the myriad number of proposals they receive is a matter of significant concern for researchers and the public alike. Despite an extensive literature on the topic of peer review and publications on criteria by which clinical investigations are reviewed, publications analyzing peer review and other processes leading to government funding decisions on large multi-site clinical trials proposals are sparse. To partially address this gap, we reviewed the outcomes of scientific and programmatic evaluation for all letters of intent (LOIs) received by the Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) between July 4, 2008, and November 28, 2016. If accepted, these LOIs represented initial steps towards later full proposals that also underwent scientific peer review. Twenty-two of 87 LOIs were ultimately funded and executed as CSP projects, for an overall success rate of 25%. Most proposals which received a negative decision did so prior to submission of a full proposal. Common reasons for negative scientific review of LOIs included investigator inexperience, perceived lack of major scientific impact, lack of preliminary data and flawed or confused experimental design, while the most common reasons for negative reviews of final proposals included questions of scientific impact and issues of study design, including outcome measures, randomization, and stratification. Completed projects have been published in high impact clinical journals. Findings highlight several factors leading to successfully obtaining funding support for clinical trials. While our analysis is restricted to trials proposed for CSP, the similarities in review processes with those employed by the National Institutes of Health and the Patient Centered Outcomes Research Institute suggest the possibility that they may also be important in a broader context.
Collapse
Affiliation(s)
- David R. Burnaska
- Cooperative Studies Program, Office of Research and Development, Veterans Health Administration, Washington DC, 20420, USA
| | - Grant D. Huang
- Cooperative Studies Program, Office of Research and Development, Veterans Health Administration, Washington DC, 20420, USA
| | - Timothy J. O'Leary
- Cooperative Studies Program, Office of Research and Development, Veterans Health Administration, Washington DC, 20420, USA
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
11
|
Zhang YF, Liu DD, Zhou Y, Lou JZ. Acute kidney injury in patients with acute coronary syndrome after percutaneous coronary intervention: pathophysiologies, risk factors and preventive measures. Cardiology 2021; 146:678-689. [PMID: 34348269 DOI: 10.1159/000517991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/20/2021] [Indexed: 11/19/2022]
Abstract
Background: Percutaneous coronary intervention (PCI) has been an effective treatment for acute coronary syndrome (ACS) patients. Acute kidney injury (AKI) is one of the common complications after PCI, which seriously affects the living quality and survival time of patients. The approach followed for the patient with AKI after PCI depends on the clinical context and may vary by resource availability. Summary: This review focuses on the pathophysiologies, influencing factors, and preventive measures of AKI in patients with ACS after PCI. The knowledge may better serve the patients and improve their outcomes. Key Messages: Many studies have been carried out for the definition and standard of AKI in the past few years. Etiologies of AKI after PCI included renal damage of contrast medium and atherosclerotic embolism, cardiac insufficiency and surgical factors on renal function. Basic conditions, treatment modalities, and perioperative changes are major risk factors of AKI. Studies have reported that the prevention of contrast-induced nephropathy, modulating the volume overload, some pharmaceuticals and blood purification treatment are helpful to prevent the occurrence of AKI.
Collapse
Affiliation(s)
- Ya-Feng Zhang
- Department of Healthcare-associated Infection Management, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Da-Dong Liu
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yue Zhou
- Department of Blood Purification Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ji-Zhuang Lou
- Department of Blood Purification Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
12
|
Shroff GR, Bangalore S, Bhave NM, Chang TI, Garcia S, Mathew RO, Rangaswami J, Ternacle J, Thourani VH, Pibarot P. Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e1088-e1114. [PMID: 33980041 DOI: 10.1161/cir.0000000000000979] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortic stenosis with concomitant chronic kidney disease (CKD) represents a clinical challenge. Aortic stenosis is more prevalent and progresses more rapidly and unpredictably in CKD, and the presence of CKD is associated with worse short-term and long-term outcomes after aortic valve replacement. Because patients with advanced CKD and end-stage kidney disease have been excluded from randomized trials, clinicians need to make complex management decisions in this population that are based on retrospective and observational evidence. This statement summarizes the epidemiological and pathophysiological characteristics of aortic stenosis in the context of CKD, evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques, and outlines the special risks in this population. Furthermore, this statement provides a critical review of the existing literature pertaining to clinical outcomes of surgical versus transcatheter aortic valve replacement in this high-risk population to help guide clinical decision making in the choice of aortic valve replacement and specific prosthesis. Finally, this statement provides an approach to the perioperative management of these patients, with special attention to a multidisciplinary heart-kidney collaborative team-based approach.
Collapse
|
13
|
Malik AO, Amin A, Kennedy K, Qintar M, Shafiq A, Mehran R, Spertus JA. Patient-centered contrast thresholds to reduce acute kidney injury in high-risk patients undergoing percutaneous coronary intervention. Am Heart J 2021; 234:51-59. [PMID: 33359778 DOI: 10.1016/j.ahj.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Contrast volume used during percutaneous coronary intervention has a direct relationship with contrast-associated acute kidney injury. While several models estimate the risk of contrast-associated acute kidney injury, only the strategy of limiting contrast volume to 3 × estimated glomerular filtration rate (eGFR) gives actionable estimates of safe contrast volume doses. However, this method does not consider other patient characteristics associated with risk, such as age, diabetes or heart failure. METHODS Using the National Cardiovascular Data Registry acute kidney injury risk model, we developed a novel strategy to define safe contrast limits by entering a contrast term into the model and using it to meet specific (eg, 10%) relative risk reductions. We then estimated acute kidney injury rates when our patient-centered model-derived thresholds were and were not exceeded using data from CathPCI version 5 between April 2018 and June 2019. We repeated the same analysis in a sub-set of patients who received ≤3 × eGFR contrast. RESULTS After excluding patients on hemodialysis, below average risk (<7%), missing data and multiple percutaneous coronary interventions, our final analytical cohort included 141,133 patients at high risk for acute kidney injury. The rate of acute kidney injury was 10.0% when the contrast thresholds derived from our patient-centered model were met and 18.2% when they were exceeded (P < .001). In patients who received contrast ≤3 × eGFR (n = 82,318), contrast-associated acute kidney injury rate was 9.8% when the contrast thresholds derived from our patient centered model were met and 14.5% when they were exceeded (P < .001). CONCLUSIONS A novel strategy for developing personalized contrast volume thresholds, provides actionable information for providers that could decrease rates of contrast-associated acute kidney injury. This strategy needs further prospective testing to assess efficacy in improving patient outcomes.
Collapse
Affiliation(s)
- Ali O Malik
- University of Missouri-Kansas City, Kansas City, MO; Saint Luke's Mid America Heart Institute, Kansas City, MO.
| | - Amit Amin
- Washington University School of Medicine, Barnes Jewish Hospital, St. Louis, MO
| | - Kevin Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Mohammed Qintar
- University of Missouri-Kansas City, Kansas City, MO; Saint Luke's Mid America Heart Institute, Kansas City, MO
| | | | | | - John A Spertus
- University of Missouri-Kansas City, Kansas City, MO; Saint Luke's Mid America Heart Institute, Kansas City, MO
| |
Collapse
|
14
|
Le S, Allen A, Calvert J, Palevsky PM, Braden G, Patel S, Pellegrini E, Green-Saxena A, Hoffman J, Das R. Convolutional Neural Network Model for Intensive Care Unit Acute Kidney Injury Prediction. Kidney Int Rep 2021; 6:1289-1298. [PMID: 34013107 PMCID: PMC8116756 DOI: 10.1016/j.ekir.2021.02.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Acute kidney injury (AKI) is common among hospitalized patients and has a significant impact on morbidity and mortality. Although early prediction of AKI has the potential to reduce adverse patient outcomes, it remains a difficult condition to predict and diagnose. The purpose of this study was to evaluate the ability of a machine learning algorithm to predict for AKI as defined by Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 or 3 up to 48 hours in advance of onset using convolutional neural networks (CNNs) and patient electronic health record (EHR) data. Methods A CNN prediction system was developed to use EHR data gathered during patients’ stays to predict AKI up to 48 hours before onset. A total of 12,347 patient encounters were retrospectively analyzed from the Medical Information Mart for Intensive Care III (MIMIC-III) database. An XGBoost AKI prediction model and the sequential organ failure assessment (SOFA) scoring system were used as comparators. The outcome was AKI onset. The model was trained on routinely collected patient EHR data. Measurements included area under the receiver operating characteristic (AUROC) curve, positive predictive value (PPV), and a battery of additional performance metrics for advance prediction of AKI onset. Results On a hold-out test set, the algorithm attained an AUROC of 0.86 and PPV of 0.24, relative to a cohort AKI prevalence of 7.62%, for long-horizon AKI prediction at a 48-hour window before onset. Conclusion A CNN machine learning-based AKI prediction model outperforms XGBoost and the SOFA scoring system, revealing superior performance in predicting AKI 48 hours before onset, without reliance on serum creatinine (SCr) measurements.
Collapse
Affiliation(s)
| | | | | | - Paul M Palevsky
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory Braden
- Baystate Medical Center, Springfield, Massachusetts, USA
| | - Sharad Patel
- Department of Critical Care Medicine, Cooper University Health Care, Camden, New Jersey, USA
| | | | | | | | | |
Collapse
|
15
|
Abstract
Drugs are the third leading cause of acute kidney injury (AKI) in critically ill patients. Nephrotoxin stewardship ensures a structured and consistent approach to safe medication use and prevention of patient harm. Comprehensive nephrotoxin stewardship requires coordinated patient care management strategies for safe medication use, ensuring kidney health, and avoiding unnecessary costs to improve the use of nephrotoxins, renally eliminated drugs, and kidney disease treatments. Implementing nephrotoxin stewardship reduces medication errors and adverse drug events, prevents or reduces severity of drug-associated AKI, prevents progression to or worsening of chronic kidney disease, and alleviates financial burden on the health care system.
Collapse
Affiliation(s)
- Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, Center for Critical Care Nephrology, School of Medicine, University of Pittsburgh, PRESBY/SHY Pharmacy Administration Building, 3507 Victoria Street, Mailcode PFG-01-01-01, Pittsburgh, PA 15213, USA.
| |
Collapse
|
16
|
Xie W, Liang X, Lin Z, Liu M, Ling Z. Latest Clinical Evidence About Effect of Acetylcysteine on Preventing Contrast-Induced Nephropathy in Patients Undergoing Angiography: A Meta-Analysis. Angiology 2020; 72:105-121. [PMID: 32830526 DOI: 10.1177/0003319720950162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures. It is the third most common cause of hospital acquired acute renal injury. As there are currently no approved therapies for CIN, prevention could be the best strategy to address this issue. Acetylcysteine may indirectly play an antioxidant role by inducing the synthesis of glutathione. Acetylcysteine can also reduce renal vasoconstriction induced by contrast medium stimulation by stabilizing nitric oxide and acting directly or indirectly on renal cortex and medulla microcirculation. To evaluate the effect of acetylcysteine on the prevention of CIN in patients after angiography, we systematically searched and analyzed the clinical data of patients including the incidence of CIN and change in serum creatinine (SCr) at 48 hours after angiography from selected articles. The result showed that acetylcysteine significantly reduces the incidence of CIN (risk ratios: 0.78, 95% CI: 0.68-0.90, I 2 = 37.3%) and the level of SCr (standardized mean difference: -0.53, 95% CI: -0.93 to -0.12, I 2 = 91.5%) after angiography compared with the control group. Overall, the use of acetylcysteine in patients after angiography was associated with a significant reduction of CIN and the level of SCr.
Collapse
Affiliation(s)
- Wenchao Xie
- Department of Cardiology, the First People's Hospital of Yulin, the Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Xiangwen Liang
- Department of Cardiology, the First People's Hospital of Yulin, the Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Zhihai Lin
- Department of Cardiology, the First People's Hospital of Yulin, the Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Ming Liu
- Department of Cardiology, the First People's Hospital of Yulin, the Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Zheng Ling
- Department of Cardiology, the First People's Hospital of Yulin, the Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| |
Collapse
|
17
|
Abstract
More than sixty years have elapsed since contrast induced nephropathy (CIN) was first described in the medical literature. This term has since been extensively explored, with a variety of studies conducted to investigate its incidence and various mechanisms examined to explain its pathophysiology. However, the topic of CIN remains one of controversy with a widely variable and often questionable incidence derived from various studies. The past two decades have seen a surge in reports questioning the existing of CIN altogether and if more harm is actually being caused to patients out of fear of this potential complication. We have attempted to review relevant studies regarding CIN and highlight the key points of its surmised understanding. The review has a higher focus on more recent literature and updates, in order to determine if an accurate estimate can be made on the incidence of CIN. While there was certainly no lack of material available, practically all the studies reviewed were limited by one or more significant drawbacks that limited the reliability of their conclusions regarding CIN. Based on the information reviewed, the strengths and the flaws encountered in other studies can be used to design a randomized control trial that may help in concluding the longstanding debate on this topic. However due to time, financial, and perhaps even ethical constraints such a trial will be difficult to arrange, and so a definitive answer on CI-AKI, and whether it really exist, may continue to elude clinicians.
Collapse
Affiliation(s)
| | - Cindy S Yip
- Department of Medicine, SUNY at Buffalo, NY, USA
| | - Pradeep Arora
- Department of Medicine, SUNY at Buffalo, NY, USA.,Division of Nephrology at VAMC, Buffalo, NY, USA
| |
Collapse
|
18
|
Nana P, Kouvelos G, Brotis A, Spanos K, Giannoukas A, Matsagkas M. The effect of Endovascular Aneurysm Repair on Renal Function in Patients Treated for Abdominal Aortic Aneurysm. Curr Pharm Des 2020; 25:4675-4685. [DOI: 10.2174/1381612825666191129094923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022]
Abstract
Aim:
The effect of endovascular aneurysm repair in patients treated for abdominal aortic aneurysm has
not been clearly defined. The objective of the present article was to provide a contemporary literature review and
perform an analysis to determine the effect of EVAR on renal function in the early post-operative period and
during follow-up.
Methods:
A systematic review of the literature was undertaken to identify all studies reporting the effect of
EVAR on renal function. Outcome data were pooled and combined overall effect sizes were calculated using
fixed or random-effects models.
Results:
Thirty-two studies reporting on 24846 patients were included. Acute renal failure after EVAR occurred
with an estimated frequency of 9% (95%CI: 5-16%; I2=97%). Median follow-up period was 19.5 months (range
1-60 months). The estimated frequency of chronic renal failure during follow-up was 7% (95%CI: 3-17%;
I2=98%). Hemodialysis was required in 2% (1-3%; I2=97%) of the cases.
Conclusion:
High-level evidence demonstrating the effect of EVAR on the incidence of acute and chronic renal
failure is lacking. Based on the current available data, nearly 10% of patients undergoing EVAR for AAA have an
increased risk for renal dysfunction after the procedure. Whether this deterioration may lead to a worse outcome
has not been adequately proved.
Collapse
Affiliation(s)
- Petroula Nana
- Department of Vascular Surgery, Medical School, University of Thessaly, Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, Medical School, University of Thessaly, Larissa, Greece
| | - Alexandros Brotis
- Department of Vascular Surgery, Medical School, University of Thessaly, Larissa, Greece
| | - Konstantinos Spanos
- Department of Vascular Surgery, Medical School, University of Thessaly, Larissa, Greece
| | - Athanasios Giannoukas
- Department of Vascular Surgery, Medical School, University of Thessaly, Larissa, Greece
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, Medical School, University of Thessaly, Larissa, Greece
| |
Collapse
|
19
|
Brar SS. The Arc of the Research Universe Is Long, But it Bends Toward the Truth. JACC Cardiovasc Interv 2018; 11:2262-2264. [PMID: 30466823 DOI: 10.1016/j.jcin.2018.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Somjot S Brar
- Regional Department of Cardiac Catheterization, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
| |
Collapse
|